When a patient begins dialysis, it’s because their important kidney function has deteriorated. At this point he or she suffers the physical and mental consequences of uremia, with all of the subsequent repercussions. Psychologically, getting to this state suddenly is a heavy blow to the patient and his or her family, who must get used to a situation for which no one is ever sufficiently prepared.
From this time on, it will be necessary to go to a dialysis center to substitute the kidney function that has been lost. In this case, dialysis is the only way to keep living or to hope to have access to other forms of substituting for the kidney function, such as automated peritoneal dialysis or a kidney transplant.
Quality of Life
Taking into account the symptoms and burdens that this illness places upon patients and their sleep cycles, ambulatory peritoneal dialysis has a few differences that weigh in its favor over hemodialysis. For one thing, with ambulatory dialysis a patient can undergo treatment while sleeping, and so it is seen as less demanding for the patient and his or her family.
Each patient’s quality of life will be determined, largely, by how well they have been prepared and to what extent they have been able avoid risk factors in the pre-dialysis phase of the disease. It’s key to come to dialysis with a good understanding of the disease. With knowledge and support, patients can confront the impact of this treatment and the underlying chronic condition of the disease.
Kidney transplants are a therapeutic method that will give patients improved quality of life, objectively and subjectively. The better that the clinic observing the patient is, the better the patient’s emotional state and social adaption to treatment will be. About 80-85 percent of transplantees demonstrate normal functioning capacity, but this percentage is less in dialysis patients. Other studies confirm psychological improvement in patients after transplant, signaling a positive evolution in self-esteem, independence, feeling of control over his or her fate, and depression. Most patients have significant level of anxiety, probably due to fear of the treatment and the risk of graft loss.
Another fundamental factor in social wellbeing is vocational rehabilitation. About 65 percent of patients in hemodialysis work (either full-time or part-time) for a year before the beginning of the treatment, but, after beginning the treatment, the percentage of patients who work descends abruptly, reaching the rate of only 25 percent of affected people. This decline isn’t so significant among transplantees (65 percent work before beginning treatment, and 46 percent afterward).
Some authors point to percentages of up to 82 percent of transplantees (5-9 years after the kidney transplant) who are working or studying.
Many patients undergoing dialysis find that they have diminished levels of sexual desire due to the changes in their physical and emotional health. For example, for men, it can become impossible or difficult to maintain an erection. When problems with tumescence are physical, there are several possibilities of treatment, from penal prostheses to medication.
Loss of sexual desire is not caused by only one factor. Also, tension and anxiety due to the illness, the treatment received and anemia (frequently associated) can alter libido and sexual capacity. Depression, which can accompany the illness, is an important factor that is frequently connected to the diminishment of sexual activity. This is a problem that requires communication with your partner and doctors; patients should try not to suffer in silence.
The loss of libido and of menstruation, or the onset of menstrual disorders, is common in women patients with kidney disorders who are treated by dialysis. Hormonal changes can produce a lack of vaginal moisture, which creates pain during intercourse. In this case, using water-soluble lubricants can be very effective.
After a kidney transplant, the hormones that cause these changes are usually normalized quickly, and the woman will usually regain her libido and fertility.
Many factors contribute to sexuality, but perhaps the most important is the feeling of intimacy through communication, confidences, common projects, etc. In the sex life of a couple, intercourse is not always necessary. Many people connect sexuality with intercourse, but sexuality has many more aspects, including a spectrum of activities that do (or don’t) include intercourse, such as caresses, kisses and hugs. All of these produce feelings of nearness, warmth and satisfaction.
Patients and their partners can fear that sexual activity can affect the patient’s health negatively. There is no reason to have any sexual limitations except those the patient feels comfortable with depending on stress or disability.
There are many forms of sexual expression that require less consumption of energy and which are totally satisfying.
Get used to asking for help from your partner, your doctor and your therapist. Patient associations and talking to people who have the same problem can be very beneficial. If you are not content with your sex life or your intimate life, don’t be quiet. Your personal satisfaction has to form part of your treatment.
The majority of patients who are subject to dialysis do not have regular menstrual cycles, and so the possibility of pregnancy is low. But, not being able to have a baby can create a sense of loss, especially in cultures in which it is expected that a couple will have descendants. If not having children is an important issue for you and your family, there are other options, such as adoption.
However, some patients undergoing dialysis have regular menstrual cycles, and so they also have the possibility of becoming pregnant. In this case, they must be careful to use effective methods of birth control; due to concerns with high blood pressure, birth control pills cannot be used.
Women who have received transplants will generally have more regular periods and the possibility of becoming pregnant will increase considerably. However, it’s is not recommended to become pregnant until at least one year after transplant, when kidney function has stabilized and the dosages of medication have been reduced. In some cases, the doctor will not recommend becoming pregnant because of the possibility of risk for the mother or because of the viability of the fetus. In the initial period after the transplant, the dose of anti-rejection medicine is large, but once the dosage has been reduced, the medicine is thought not to have negative affects on the child. Nevertheless, the side effects on a larger scale are not known. Pregnancy in a woman who has had a transplant is always going to be considered risky.
For more information, get in contact with a family planning center and ask experts to assess the methods best suited to your case. In the case that you do not want to have children, the best recommendation is for the couple to have a vasectomy or tubal ligation. An IUD is not recommended because of the risk of infection.
Until recently, experts have recommended that mothers who have had transplants feed their babies formula, because breast milk can contain some of the medicines that the mother is taking. But now, some experts believe the concentrations of immunosuppresants in mother’s milk are below toxic levels, and that breastfeeding is possible.
In Chronic Kidney Disease (CKD), patients will observe changes in their metabolisms and in the way their bodies process nutrients, which can lead to malnutrition. During dialysis, some of these changes can be corrected, however the changes may also trigger other factors that will further impoverish the nutritional state.
Because people who have undergone peritoneal dialysis have a high incidence of malnutrition, doctors look to treat and prevent it in the early identification stages of the pre-dialysis period.
Prevention of malnutrition
It’s important that ingesting macro nutrients (such as proteins and carbohydrates) and micro nutrients (vitamins and trace elements) will be sufficient. A deficit in nutrition can pass unnoticed for a long time without exhibiting any symptoms.
- Proteins: at least 1.2 gr/kg of body weight
- Energy intake: at least 32 Kcal/kg. From this energy, from 35 to 50 percent should be from the intake of fats, predominately polyunsaturated fats.
- Water and salt intake depending on the individual
- Calcium: it may be necessary to take a calcium supplement to make up the daily intake of 800 to 1000 mg.
- Magnesium: 200-300 mg daily is recommended
- Vitamins: Individually, as needed (vitamin D, folic acid, vitamin B complex and trace elements)
When the preventative measures are insufficient, patients can try to improve their nutritional state with other nutritional supplements:
- Oral: Most effective in doses of proteins of 15 g/day. When these are taken in large amounts, the body may not tolerate it.
- Intraperitoneal: A mix of amino acids both essential and non-essential. This is limited by the quantity that can be used in 2-4 L and may require an increase in the amount of dialysis that the patient is receiving.
- Factors of recombinant growth (growth hormone and somatomedin C): the results are disparate and have many side effects. It seems that these are most effective in low, frequent doses.
Maintaining a normal nutritional level is one of the principal factors for surviving kidney disease. To prevent developing malnutrition, the following is recommended:
- Ensure that your diet incorporates an adequate quantity of proteins, calories, vitamins and minerals
- Reevaluate your nutritional state every two or three months
- Measure your residual renal function every three months
- Take the lowest amounts of medicine possible
- Stay healthy; control any other illnesses you might get
Foods contain the proteins, carbohydrates, fats, vitamins, minerals and water that are necessary for living. All of these substances produce residual matter, which is in part eliminated by the kidneys. When kidneys don’t function correctly, these residuals accumulate and can be harmful to the health.
To avoid this, it’s recommended to follow a special diet depending on the stage of your illness. Following the recommended diet is essential, and forms part of the treatment you are given by your medical team.
Nutrition during pre-dialysis
In this stage you may find these typical symptoms:
In this stage, it’s usually recommended to follow a diet that is:
Poor in proteins and phosphorus. Restrict the intake of milk, cheese, nuts and carbonated beverages, as they are rich in phosphorus.
- Rich in carbohydrates.
- Restricted in salt.
- Has liquid intake in relation with your amount of urine output.
- Features careful amounts of foods rich in potassium, such as fruit, vegetables, chocolate, etc.
Nutrition during hemodialysis
- Increased protein intake, because hemodialysis will eliminate the residual waste.
- Restrict the amount of liquid, because it will only be eliminated once every two days. Retention of liquid can provoke a rise in blood pressure.
- Watch your weight, which should not fluctuate more than two kilos between sessions.
- Monitor intake of food and beverages that are rich in potassium.
- Be sure to take the medicine that will help avoid absorbing too much phosphorus from foods.
Nutrition during peritoneal dialysis
- Portions of proteins can be larger than in the pre-dialysis period.
- There is less probability that liquid and wastes will accumulate because at this point the dialysis is being done almost 24 hours a day.
- A medicine to avoid the absorption of too much phosphorus from food must be taken.
- Liquids may be taken liberally, according to thirst.
- Avoid weight gain.
Nutrition during the transplant period
- Avoid weight gain, eating fats or retaining liquids.
- Diet can be fairly free, but salt intake should be restricted.
- • The medication can increase a patient’s appetite and thus cause them to gain weight. This should be monitored and avoided.
Minerals are inorganic chemical elements, which function in many of the biological processes necessary for growth and good health. Different minerals form an essential part of enzymes and participate in numerous functions also within the human body: the transport of oxygen, blood coagulation, muscular contractions, etc.
It’s necessary to distinguish between minerals and trace elements. When the body requires more than 100 mg/day of an element, this is called a mineral. When the daily necessity is less than 100 mg per day, we call it a trace element. Even when the dose necessary is quite low, they are essential to good health, and the absence of minerals or trace elements in the diet can cause changes in the body that must be prevented by taking supplements.
To be considered an essential trace element, it must meet the following requirements:
- Insufficient intake causes functional deficiencies that will be recovered once intake is again adequate.
- The body cannot grow or complete its processes without the presence of this element.
- It has a direct influence on the body and is involved in the metabolic process.
- The overall effect of the element in question cannot be obtained by using any other element.
The essential elements are the following: zinc, selenium, copper, manganese, chromium, molybdenum, fluoride, iron, cobalt, etc.